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July 9, 2015

Chronic Hepatitis C

According to the World Health Organization, about 130–170 million people are chronically infected with the Hepatitis C virus, with more than 350,000 people dying from Hepatitis C-related liver diseases each year. Hepatitis C is an infectious liver disease that varies in severity from a minor illness lasting a few weeks to a serious, lifetime illness that attacks the liver. It is produced with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. This can happen when an individual shares needles with others when using drugs, or being pricked by an unsanitary needle in a hospital or doctor’s office. It can also be spread through having sex with someone who has the disease. Hepatitis C can be either “acute” or “chronic.” Chronic Hepatitis C is s a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems and liver cancer.

Causes

Hepatitis C is caused as the result of a direct transmission of the hepatitis C virus through infected blood. This means the infected blood must be absorbed through the skin and enter the bloodstream of another person – in other words, blood-to-blood.

Risk Factors

Those people who are at increased risk for Hepatitis C, include:

  • Current injection drug user
  • Past injection drug users
  • Recipients of donated blood, blood products, and organs
  • People who received a blood product for clotting problems
  • Hemodialysis patients or persons who spent many years on dialysis for kidney failure
  • People who received body piercing or tattoos done with non-sterile instruments
  • People with known exposures to the Hepatitis C virus, HIV-infected persons
  • Children born to mothers infected with the Hepatitis C virus

Signs & Symptoms

Many patients with Chronic Hepatitis C experience no symptoms; therefore, many individuals do not know they have this condition until some sort of blood test is done and doctors find issues with a person’s liver enzymes and liver function.

Those with the disease may notice feelings of:

  • Fatigue
  • Upset Stomach
  • Lack of Appetite
  • Joint and Muscle Pain

Those who have had Chronic Hepatitis C for a long period of time may also have a condition known as Cirrhosis. This causing one’es liver to scar over, creating:

  • Jaundice
  • Dark Yellow Urine
  • Increased Bruising

Screenings & Diagnostic Tests

Several blood tests can be taken to see if you have Chronic Hepatitis C. They include:

A Hepatitis C Virus Test - this is a blood test that looks for antibodies against the hepatitis C virus. It shows whether you have been exposed to the virus.

Genetic Test - this is a blood tests that look for the genetic material of the hepatitis C virus. This test shows whether you are infected with the virus now.

Hep C Genotype Test - one should take a blood test to find out the kind of hepatitis C virus genotype you have. Knowing your genotype will help you and your doctor decide if and how you should be treated.

Liver Function Blood Test - this is a test which helps the doctors determine if you have any liver damage or a liver biopsy and will tell them if the virus has caused scarring or damage to the liver.

Treatment

Individuals who have been detected with chronic Hepatitis C will be treated with various combinations of medications. The type of treatment as well as the length of treatment for Hepatitis C is dependent on the genotype of the virus. Working closely with one’s physician will help in shaping the best course of action. Some newer treatment options for Hepatitis C no longer include medications with types of interferon, the first drug that was effective in treating hepatitis C but which had a lot of difficult side effects. Newer all-oral treatments are medicines which directly stop the virus from reproducing so the body’s immune system can remove virus from the body. These now have cure rates of 90% or approaching 100% for MOST hepatitis C patients.

Some generic (and brand, manufacturer) names of medications used in treating Chronic Hepatits C include:

  • Simprevir (Olysio) used only in some drug combinations
  • Sofosbuvir (Sovaldi, Gilead) with or without ledipasvir (Harvoni)
  • Vierapak - used to treat Hep C Virus Genotype 1 and contains four medications:
    • Ombitasvir - an inhibitor of hepatitis C virus NS5A protein
    • Paritaprevir - an inhibitor of hepatitis C virus NS3/4A protease
    • Dasabuvir - an inhibitor of hepatitis C virus NS5B polymerase
    • Ritonavir - has no activity against hepatitis C virus. It is a strong
    • CYP3A4 inhibtor that is added to the formulation to inhibit paritaprevir metabolism and increase its blood levels
    • Ribavirin (Rebetol, Ribasphere) used only in some drug combinations
    • Pegalyted Interferon injections weekly, used in some drug combinations
    • Other new medications/combinations in oral form are on the immediate horizon
    • Treatment Outlook

      If treatment functions properly in the body, Chronic Hepatitis C virus will not show in the body after 3 to 6 months of ending treatment. This seems to mean true viral cure, not just that the virus is dormant. Make sure to regularly see your doctor and keep healthy habits.

      The outlook for most people with chronic hepatitis C is good. People who get cirrhosis and liver disease may need a liver transplant, but treatment done in time can prevent this. Keep in mind that people who have cirrhosis but get a viral cure are still at risk of liver cancer and continue to need regular liver ultrasound exams and followup by gastro or liver specialists.

      Lifestyle and Home Remedies

      Unfortunately, the most effective newer all-oral treatments can cost upward of $84,000 for a treatment of 12-24 weeks. Although patients who have more serious forms of hepatitis C, those with definite cirrhosis for example, will get approved by insurance plans almost without question, those with much milder forms of disease may not get approval because of cost. The idea is there is little harm to wait and watch, until drug costs come down over time and with more competition. Our inSite physicians believe in treating hepatitis C whenever it is feasible since cure is now so reachable, but when it is not financially feasible to obtain coverage, we counsel patience and we will try again periodically to get approval. Regular visits or contacts with us can help keep the timing of treatment optimal.

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      Additional Information

      Hep C 101